Disheaux, Shane Michael
Disheaux, Shane Michael is an individual health care provider with primary practice located at 2827 Northgate Blvd , Fort Wayne IN 46835-2903. He recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Occupational Therapy Assistant, which is considered as his primary health care specialty. Disheaux, Shane Michael can be contacted via phone (260) 492-1498.Contact Information
Primary practice address
2827 Northgate Blvd
Fort Wayne IN 46835-2903
Phone: (260) 492-1498
Fax: (260) 492-1674
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Occupational Therapy Assistant | 224Z00000X | 32001345A | Indiana |
Profile Details
| NPI number | 1508063645 |
|---|---|
| LBN Legal business name | Disheaux, Shane Michael |
| Credentials | Certified Occupational Therapy Assistant (COTA) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 2nd, 2007 |
| Last updated | Jul 8th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1508063645 | NPPES |
| Indiana | MEDICAID | 1555-656 |
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